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Appropriately identify patients for
short-term care management interventions
• An Effective Program is…
– Designed to reduce ER visits, hospital visits and LOS
– Short term (currently not exceeding 90 days)
– Evidence based
– Measureable
– Focused on potentially preventable events
• Preventable Hospitalizations are:
– Clinician identified preventable events most appropriate for care management.
– Events where Outpatient Care Management (OPCM) intervention can reduce
hospital encounters (ED/IP/OBS) within a 90-day time period
– Impactable in a measurable way, with defined outcomes.
Episodic Care Management Defined